Health Care and Public Health

Health care reform is clearly a complicated subject, but I think the single most compelling isolated factoid in favor of reform is the basic reality that Americans spend wildly more on health care than any other developed country and yet lead shorter lives than the residents of most developed countries. Now, clearly, there’s a bunch one could say on this subject. But one common counterargument I’ve never understood is this line from Gary Becker:

National differences in life expectancies are a highly imperfect indicator of the effectiveness of health delivery systems.for example, life styles are important contributors to health, and the US fares poorly on many life style indicators, such as incidence of overweight and obese men, women, and teenagers. To get around such problems, some analysts compare not life expectancies but survival rates from different diseases. The US health system tends to look pretty good on these comparisons.

For one thing, the US actually doesn’t look especially good on those comparisons.

But for another thing, the reality that delivering health care services is not a very effective way of delivering good health outcomes is itself a powerful point against the American system. After all, one reason we spend so much on health care is that spending a huge proportion of national income on making people healthier seems like a perfectly reasonable idea. But if it turns out that spending money on health care isn’t an effective way of promoting good health outcomes, then that means we’re doing something badly wrong. We should, it seems, be spending less on health care and more on nutritious food and gym memberships and schools (educational attainment is highly correlated with good health outcomes) and anti-poverty spending.

To put it another way, imagine a right-of-center economist arguing about foreign aid. He’d point to the fact that Africa’s gotten more aid than East Asian countries that have done much better as a reason to be skeptical that our aid programs are effective. If I turned around and tried to say “no, no, it’s not that our aid programs don’t work, it’s just that foreign aid isn’t very useful in promoting economic growth” I don’t think anyone would be very impressed by that counterargument. The legitimate reason to spend vast sums of money on health care would be to reap large health benefits. The fact that we’re not seeing large health benefits indicates that we’re doing something wrong.